5-RFP 05 Verification of Authorized Offeror Form.pdf

This is a Verification of Authorized Offeror Form issued by the Incorporated County of Los Alamos Procurement Division in New Mexico for the solicitation of Long-Term Disability Benefits for Los Alamos County. The form serves as the official submission document through which qualified offerors designate their authorized representative who can obligate the organization in providing the requested services. The County is seeking proposals from licensed and qualified offerors to provide a fully insured, contributory Long-Term Disability (LTD) Benefits Plan for eligible County employees. The form requires offerors to complete and submit detailed information including the solicitation number, solicitation title, authorized offeror identification, organizational details, and contract manager information as part of their proposal submission.

The form captures essential organizational and contact information required for the County's procurement records, including the offeror's legal name, state of incorporation, federal tax identification number, New Mexico Business Tax Identification Number (if applicable), physical and mailing addresses, email address, and telephone number. By completing and signing this verification form, offerors confirm they have reviewed the proposal conditions, examined the scope of services and deliverables, and are authorized to submit a binding proposal. This document ensures that only duly authorized representatives execute proposals and protects the County by establishing a clear point of contact for contract administration and performance obligations.